Special Stains - Medicare Advantage

This Humana Medicare Advantage policy affirms coverage of special histochemical stains, immunohistochemical stains, and morphometric analyses when they are reasonable and necessary for diagnosis or treatment and meet applicable Medicare LCD/NCD criteria. Coverage is guided by the referenced LCDs (e.g., L35922, L36351, L36353, L36805, L35986); services not meeting those criteria, or services excluded under federal regulation, are not covered. Documentation must demonstrate clinical indication, specimen details, correlation with H&E findings, and adherence to applicable LCD medical necessity criteria.

"Histological examination (including special histochemical stains and immunohistochemical (IHC) stains) to diagnose, assess severity, and provide prognosis for numerous pathological conditions (i."

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